Acute GI Bleeding Flashcards
What is upper GI bleeding?
Proximal to ligament of Trietz
- Oesophagus
- Stomach
- Duodneum
What is the clinical presentation of upper GI bleeding?
- Haematemesis
- Melaena
- Elevated urea
- Dyspepsia, reflux, epigastric pain
- NSAIDs use
What is haematemesis?
Vomiting of blood
May be red or look like coffee grounds
What is melaena?
Black motions often like tar, with a characteristic smell of altered blood.
What are the oesophageal causes of upper GI bleeding?
- Oesophageal ulcer
- Oesophagitis
- Oesophageal varices
- Mallory Weiss tear
- Oesophageal malignancy
What are the stomach causes of upper GI bleeding?
- Gastric ulcer
- Gastritic
- Gastric varices
- Gastric malignancy
- Dieulafoy
- Angiodysplasia
What are the duodenal causes of upper GI bleeding?
- Duodenal ulcer
- Duodenitis
- Angiodysplasia
What are the most common causes of upper GI bleeding?
Peptic ulcers
Gastritis
Oesophagitis
Erosive duodenitis
Varices
Portal hypertensive gastropathy
Malignancy
Mallory Weiss tear
Valvular deformation- angiodysplasia, dieulafoy
What are the risk factors for peptic ulcers?
H. pylori
NSAIDs
Aspirin
Alcohol excess
Systemic illness
What are varices?
Abnormally dilate collateral vessels
What varices are most common?
Oesophageal- 90%
Gastric- 8%
Rectal and splenic- rare
What is Mallory- Weiss tear?
Linear tear to GO junction
Follows period of retching/vomiting
What is angiodysplasia?
Vascular malformation anywhere along the GI tract
Frequent cause of chronic occult or overt occult bleeding
What is diuelafoy?
Submucosal arteriolar vessel eroding through mucosa in the gastric fundus
What is lower GI bleeding?
Distal to ligament of Trietz
- Jejunum
- Ileum
- Colon
What is the clinical presentation of lower GI bleeding?
- Fresh blood/clots
- Magenta stools
- Normal urea
- Typically painless
- More common in advanced age
What are the causes of lower GI bleeding?
Diverticular disease
Haemorrhoids
Vascular malformations
- Angiodysplasia
- Arteriovenous malformation (AVM)
Neoplasia
- Carcinoma
- Polyps
Ischaemic colitis
Radiation enteropathy/proctitis
IBD
- UC
- CD
What is diverticular disease?
Protrusion of inner mucosal lining through the outer muscular layer forming a pouch
What is haemorrhoids?
Enlarged vascular cushions around anal canal
What is lower GI neoplasia?
Colonic polyps or carcinoma
What is ischaemic colitis?
Disruption in blood supply to colon
What is radiation proctitis?
History of radiotherapy:
- Cervical cancer
- Prostate cancer
What are the small bowel causes of lower GI bleeding?
- Meckel’s diverticulum
- Small bowel angiodysplasia
- Small bowel tumour/ GIST
- Small bowel ulceration (NSAID associated)
- Aortoentero fistulation (following AAA repair)
What are the steps for management of acute GI bleeding?
- Resuscitation
- Risk stratification
- Diagnosis + treatment
- Upper GI: Endoscopy
- Lower GI: Colonoscopy or CT angiogram
- Withhold/reverse contributory medications
- Specific medications
- PPI
- Tranexamic acid
- Consider CT angiography/interventional radiography/ surgical interventions
What is the management for peptic ulcers?
Endoscopy
PPIs
Angiography with embolization
Laparotomy
What is the management for varices?
Endoscopy
Terlipressin
Antibiotics
Reverse abnormal coagulation
Sengstaken blakemore tube
Transjugular intrahepatic portosystemic chunts (TIPSS)
